Reasons for Using Cannabis Among Adults in the United States: Associations with Demographics, Health Behaviors, Chronic Conditions, and Legal Status.
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Background: Several factors influence reasons for cannabis use in the U.S. This study examines reasons for cannabis use (recreational only, medical only, both) and their frequency of use in association with demographic variables, health-risk behaviors, legal status, and chronic disease. Methods: We performed a cross-sectional analysis of 466,355 adults (aged ≥18) in the 2018-2021 BRFSS surveys in areas that administered the cannabis module. The primary outcome variables were whether cannabis was used in the past 30 days and, if so, reasons for its use and the number of days of use. Regression techniques were used to assess these outcome measures according to selected variables. Results: Approximately 11.5% (SE = 0.1%) used cannabis in the past 30 days. The reasons for use were 36.7% (SE = 0.5%) recreation only, 36.4% (SE = 0.5%) medical and recreation, and 26.9% (SE = 0.4%) medical only. Cannabis use was significantly greater in areas where it was legal for medical and recreational use, but among those who used it, reasons for its use were not significantly associated with legal status. Among those who used cannabis in the past 30 days, using it for recreation only versus medical reasons only was significantly greater in the youngest age group, men, NH Blacks, never married, employed, students, college/technical school graduates, binge drinkers, never smokers, and non-obese and in the years 2020-2021 (vs. 2018-2021). Using it for both medical and recreational reasons versus medical reasons only tended to show similar results. Among those who used cannabis in the past 30 days, the mean number of days of cannabis use was 6.8 (SE = 0.3) days greater for those who used it for medical and recreational reasons vs. recreation only and 5.7 (SE = 0.3) days greater for those who used it for medical reasons only vs. recreation only, after adjusting for several potential confounders. Mean number of days of cannabis use varied significantly across the levels of several variables, including chronic disease status, in the adjusted model. Of those who used cannabis in the past 30 days and had arthritis, asthma, CHD, COPD, depression, diabetes, a heart attack, kidney disease, or cancer, less than half used it for medical purposes only. Conclusions: Cannabis use is more common in areas where it is legal for medical and recreational use, but legal status is not significantly associated with reasons for use. Those who use cannabis for medical purposes use it more often than those who use it for recreation only. Reasons for cannabis use vary by the levels of several variables, including chronic disease status. Less than half of those with a chronic disease use it solely for medical purposes.